The Trauma Triad of Death

The Trauma Triad of Death

The Trauma Triad of Death describes the three top causes of mortality in patients suffering major trauma(1,2). The three conditions most associated with death in patients suffering severe traumatic injuries are: hypothermia, acidosis and coagulopathy(1).



These three factors have a complex positive feedback relationship between themselves. For example, a severe haemorrhage can lead to hypovolaemia and subsequent hypothermia due to decreased circulation. This hypothermia and hypoperfusion can hold back the clotting cascade from activating effectively and lead to coagulopathy. Prolongued tissue and organ hypoxia due to hypoperfusion leads to anaerobic metabolism resulting in the release of lactic acid and ketones and causing metabolic acidosis. Metabolic acidosis in turn can negatively affect performance of the myocardium, further contributing to hypoperfusion(1).


Extended hypothermia combined with hypoperfusion can lead to Multiple Organ Dysfunction Syndrome (MODS)(3). One study found that almost half of all patients with severe traumatic injuries suffered from MODS(3).
As such, early haemorrhage control along with early temperature monitoring are essential in the management of patients suffering major trauma. Providing personnel at risk of encountering major trauma with highly performing equipment meeting professional standards for trauma management is essential.



1) Mikhail, J. (Feb 1999), "The trauma triad of death: hypothermia, acidosis, and coagulopathy", AACN Clin Issues, 10 (1): 85–94
2) Lewis, Anne Marie (Mar 2000), "Trauma triad of death emergency", Nursing, 30 (3): 62–4
3) Keane M. Triad of death: the importance of temperature monitoring in trauma patients. Emerg Nurse. 2016 Sep;24(5):19-23